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,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,L/O/G/O,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,GIP and Bariatric Surgery,GIP and Bariatric Surgery,Contents,背景介绍,GIP相关知识,减重手术,综述结论,5,2,3,4,1,背景知识,治疗T2DM的两种理论,Contents背景介绍GIP相关知识 减重手术综述结,背景介绍,减重手术(,Bariatric Surgery,)是目前治疗病态肥胖症最有效的治疗方法,同时可以治疗肥胖合并症如2型糖尿病(T2DM)、高血压、高血脂等。但目前减重手术减肥和治疗T2DM的治病机理存在争议。传统认为减重手术阻碍食物吸收和引起消化不良是减肥和改善T2DM的唯一治疗机制。现在发现,Bariatric Surgery,之后改变了一些胃肠激素的分泌和作用,减轻体内胰岛素抵抗而起治疗作用。其中GIP的生理作用及手术后的改变备受争议。,背景介绍减重手术(Bariatric Surgery)是目前,GIP,相关知识,GIP在人体中的生理作用,GIP在肥胖者和T2DM体内的作用,GIP和GLP-1的不同,减重手术如何引起,GIP的改变,GIP相关知识 GIP在人体中的生理作用 GIP在肥胖者和T,GIP,在人体中的生理作用,GIP,主要由分布于十二指肠和空肠的,k,细胞分泌,在健康人体中主要有以下生理作用:,1,、,GIP,是一个,生理性肠降血糖素,,有葡萄糖依赖的,促胰岛素分泌,作用;,2,、,GIP,能引起餐后胰高血糖素的升高;,3,、,GIP,能预防胰岛,细胞的凋亡和促进胰岛,细胞的增殖;,4,、,GIP,能促进葡萄糖的吸收、,葡萄糖转化为脂肪酸,及,脂肪在脂肪组织的沉积,;,5,、,GIP,妨碍骨质吸收,促进骨的形成;,6,、,GIP,对人体胃能动性作用小。,GIP在人体中的生理作用GIP主要由分布于十二指肠和空肠的,GIP,和,GLP-1,的不同,GIP和GLP-1的不同,GIP,在肥胖者和,T2DM,体内的作用,The cause of this GIP resistance is,down -regulation,(下调),of GIP receptors,in type 2 diabetic patients .,It is important to note that certain polymorphisms of TCF7L2 protein are associated with GIP resistance.,Animal experiments have shown that,high fat diet,causes a,proliferation(,增生,) of GIP,producing K cells in the duodenum.,GIP在肥胖者和T2DM体内的作用The cause of,GIP,在肥胖者和,T2DM,体内的作用,GIP在肥胖者和T2DM体内的作用,GIP,在肥胖者和,T2DM,体内的作用,结论,:,GIP,在,肥胖者和,T2DM,体内含量增加,这导致,胰岛素抵抗,和葡萄糖依赖,胰岛素分泌功能,受损。因此,降低患者体内,GIP,含量,可用来治疗肥胖型,T2DM.,GIP在肥胖者和T2DM体内的作用结论:,减重手术如何引起,GIP,的改变,减重手术如何引起GIP的改变,减重手术如何引起,GIP,的改变,In a study by Rudnicki et al. on rats, it was found that the presence of,food and bile,(胆汁),is necessary,for the secretion of GIP.,GIP can explain the findings of this experiment as preventing,exposure,of the proximal gut to digested food (food + bile) causes,decreased secretion of GIP,.,结论:,减重手术改变了食物的流向,使十二直肠和空肠处的,k,细胞营养缺乏,,因此导致,k,细胞分泌,GIP,的量减少。,减重手术如何引起GIP的改变In a study by Ru,治疗,T2DM,的理论,后肠道理论 (,The hindgut theory),肠道理论,前肠道理论 (,The foregut theory),治疗T2DM的理论后肠道理论 (The hindgut th,后肠道理论,(,The hindgut theory,),减重手术使食物提前进入回肠,食物刺激诱导后肠激素分泌,这种激素被认为是,GLP-1,,它可以调控胰岛内分泌功能,增加胰岛素的合成和,/,或释放,改善外周组织对胰岛素敏感性,从而达到控制糖尿病的作用 。,后肠道理论 (The hindgut theory),前肠道理论,(,The foregut theory,),手术前,,糖尿病易感者,的上消化道经食物刺激产生“胰岛素抵抗因子”,使人体产生,胰岛素抵抗,现象。手术后,营养物质避开对胃十二指肠的刺激,减少“胰岛素抵抗因子”等物质的释放,导致,2,型糖尿病的胰岛素拮抗减轻或消失。研究认为这种胰岛素抵抗因子对抗,GIP,作用。,前肠道理论 (The foregut theory),两种理论的争议,Wang et al. showed in an experiment using a non-obese rat model that the duodenojejunal bypass (,a foregut operation,) and the ileal transposition (,a hindgut operation,) are,equivalent,in terms of weight loss and decrease in blood glucose levels.,结论,:研究发现两种理论可能都成立,减肥手术中它们共同起作用。,两种理论的争议Wang et al. showed in a,减重手术,Roux-en-Y,胃旁路术,(,Roux-en-Y gastric bypass,RYGB),胆胰转流术,(biliopancreaticdiversion,,,BPD),腹腔镜可调节胃捆绑术,(laparoscopicadjustablegastricbanding,,,LAGB),胃空肠旁路术,(gastrojejunalbypass,,,GJB),垂直捆绑胃成形术,(verticalbandedgastroplasty,,,VBG),十二指肠空肠旁路术,(duodenal-jejunalbypass,,,DJB),空肠回肠旁路术(,Jejunoileal Bypass,,,JIB),减重手术Roux-en-Y胃旁路术( Roux-en-Y g,Roux-en-Y,胃旁路术(,RYGB,),Roux-en-Y gastric bypass (RYGB),Roux-en-Y胃旁路术(RYGB)Roux-en-Y g,Roux-en-Y,胃旁路术(,RYGB,),Whitson et al. reported that there was,no change,in GIP levels 6 months postoperatively in both diabetic and non-diabetic patients after RYGB.,Rubino et al. found that fasting GIP levels were,reduced,after RYGB only in diabetics but not in non-diabetics.,Laferrere et al. found that meal stimulated GIP levels were found to be,increased,1.5 times after RYGB .,结论,:在,大多数研究报告,中,餐后,GIP,含量降低;在一些研究报告中,空腹,GIP,含量降低。,Roux-en-Y胃旁路术(RYGB)Whitson et,胆胰转流术(,BPD,),手术方法:切断,胃,后,于,Trietz氏韧带下约50cm处分离、切断,空肠,,空肠远端与胃近端吻合,;近端空肠端侧吻合于距回盲瓣50cm处。,胆胰转流术(BPD)手术方法:切断胃后,于Trietz氏韧带,胆胰转流术(,BPD,),Guidone et al. found both fasting and postprandial GIP significantly,reduced,1 and 4 weeks after BPD.,Mingrone et al. reported that BPD caused a significant,decrease,in area under the curve (AUC) for GIP and this was more so in diabetic subjects.,Salinari et al. found that area under the curve for GIP was,decreased,by fourfold 1 month after BPD in diabetic patients.,结论,:,目前实验结果表明,与,RYGB,手术相比,,BPD,手术之后,GIP,降低更加具有统一性。,胆胰转流术(BPD)Guidone et al. found,腹腔镜可调节胃捆绑术,(LAGB),结果:,可以随时随意调节胃容量的,,,是进入体内的食物量减少,方法,:,可调节的硅胶带环形捆绑胃中上部,硅胶带的一端自腹部引出体外,可用于术后手动调节,腹腔镜可调节胃捆绑术(LAGB)结果:可以随时随意调节胃容量,腹腔镜可调节胃捆绑术,(LAGB),Shak et al. showed that GIP was,unchanged,after LAGB at 6 and 12 months post surgery.,In the study by Korner et al., the AUC for GIP (fasting to 180 min after meal) was,greater than,that for RYGB and this was statistically significant.,结论,:,目前研究结果,说明,LAGB,手术不会导致,GIP,的降低。,腹腔镜可调节胃捆绑术(LAGB)Shak et al. sh,十二指肠空肠旁路术(,DJB,),结果:,DJB后,食物不经过十二指肠和空肠上段,方法:,离断,十二直肠,起始部和上端,空肠,,将空肠远侧断端与十二指肠近端端吻合,。,十二指肠空肠旁路术(DJB) 结果:方法:离断十二直肠起始部,十二指肠空肠旁路术(,DJB,),Cohen et al. reported that DJB in non-morbidly obese diabetic humans was,safe and effective,in causing,resolution of diabetes .,Lee et al. reported there was,no change,in the AUC of total GIP.,结论,:,尽管需要进一步的研究,但由此也可以推断,GIP,可能不是前肠理论的中介物。,十二指肠空肠旁路术(DJB)Cohen et al. rep,Jejunoileal Bypass(JIB),方法,:将,空肠近,端与,回肠,远端部分吻合,,结果:,JIB,后,食物绕过小肠营营养吸收段。,Jejunoileal Bypass(JIB)方法:将空肠近,Jejunoileal Bypass(JIB),Naslund et al. reported that,elevation,of GIPmore in the 20-year group after JIB.,Ockander et al. reported that,Increased,density of GIP cells in JIB group.,结论,:上述研究发现,JIP,手术后患者,GIP,的含量没有降低。,Jejunoileal Bypass(JIB)Naslund,综述结论,GIP,是一个肠降糖激素,与肥胖症和T2DM有密切联系。它在肥胖者和葡萄糖不耐者体内含量,升高,。,减重手术后,,,大部分,的人类研究报告指出人体内,GIP含量减低,。,患者,体内过高的GIP具有,胰岛素抵抗,,它的,降低,对肥胖者和T2DM患者是,有益,的。所以在治疗肥胖型糖尿病时,GIP拮抗剂可能更有用。故研究GIP拮抗剂,也为治疗肥胖型糖尿病开辟了一条新的道路。,综述结论GIP是一个肠降糖激素,与肥胖症和T2DM有密切联系,thank you!,thank you!,
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